Internship program connects Latino students with careers in health care
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Preparing for the project management professional (PMP) exam can be daunting. With a wealth of PMP prep resources available across the internet, you might feel overwhelmed, uncertain or confused about which resources are the best.
Creating an effective personal study plan with goals and deadlines and using the best exam prep resources will help to ensure your PMP certification success.
In this article, we share some strategies and PMP exam prep resources to help you prepare to take the test. Options vary from short practice questions to PMP prep courses. Let’s dig in.
With the PMP exam costing up to $555 per attempt, intentional preparation is critical for saving money, time and energy. The Project Management Institute (PMI) administers the PMP exam. PMI states that successful test-takers spend 35 hours or more on exam prep.
The following considerations can help you pass the PMP exam on the first try.
PMP candidates must complete at least 35 contact hours of formal project management education before they can take the certification exam.
You can build these contact hours through the following avenues:
Once you complete your contact hours, it’s time to set a test-taking timeline.
The American Psychological Association suggests stretching your study time over a more extended period to help you better retain information. For example, if you aim to complete 35 total hours of studying, it is better to study for three to four hours per week for nine to 11 weeks rather than 12 hours per week over three weeks.
Last-minute cram sessions can be helpful for short-term information retention, but spacing out your study sessions results in better recollection.
After you determine how long your preparation should take, schedule out study time and practice questions leading up to exam day.
Practice exams are a great way to track your progress and test how well you recall the exam material. You don’t need to take the full 200-question test every time. Shorter, more focused tests can help you identify improvement areas and strengthen your knowledge of specific subjects.
Toward the end of your preparation period, make sure you are ready for exam day by taking the paid, PMI-authorized practice exam. This VCE exam follows the same format as the PMP certification exam, giving you a true feel for the official test’s design, questions and time frame.
The following resources, excluding PMI’s official Project Management Body of Knowledge Guide (PMBOK® Guide), are completely free and can be used for self-study and reference purposes.
The PMBOK Guide is the foundational resource for all things project management. It details the best practices, terminologies and guidelines that all project managers should know. The PMBOK Guide is a must-have resource for any project manager. It costs only $99 and is free to PMI members.
PMPPracticeExam.org is a free, no-frills resource that helps you prepare for the PMP exam. The site offers four practice PMP exams, each of which contains 50 multiple-choice questions covering three domains: people, process and business environment. This VCE exam reflects the same proportions found on the official PMP exam.
Each VCE exam is instantly scored and provides detailed explanations for questions answered incorrectly.
PM PrepCast offers a free, 120-question practice test. Each question connects to a specific project management knowledge area and domain. This resource includes a test-timer and a marking feature for self-review. If you are struggling to answer a practice question, you can use the hint button.
PM PrepCast also offers a project management exam simulator for $149. This resource includes over 2,280 demo questions with detailed answer notes and helpful references to further your learning.
As a PMI-authorized training partner, the Project Management Academy offers a free 50-question training exam to all users. The organization also features 2,000 additional practice questions for Project Management Academy students.
The Project Management Academy’s practice exam is based on PMBOK Guide topics. Your exam results include explanations for every answer. Keep in mind that to receive your exam results, you must input your name and email address.
Quizlet’s user-created study set includes over 1,500 terms and definitions. Quizlet is free, does not require an account and offers multiple self-study options, including a flashcard feature.
With an account, you can use Quizlet’s term-matching feature. You can also generate a test that includes written-answer, multiple-choice, true-or-false and matching questions. If you want a more advanced learning experience, the Study Path feature uses your individual goals to create a study plan.
BrainSensei offers two PMP training modules and a mini practice exam. This resource offers a seven-day free trial.
Each module uses an interactive slide deck and videos to teach project management concepts. The first module is an overview of project management, and the second focuses on initiating a project. Each unit offers self-assessment opportunities, which require users to drag and drop the appropriate vocabulary terms into their correct respective spaces.
This VCE exam resource is free and comprises 25 questions. Tests.com organizes its PMP practice questions into five sections, aligned with the five steps of the project life cycle: initiating, planning, executing, monitoring and controlling and closing. Each question is multiple-choice and includes a short description.
This resource is best for quickly testing your knowledge of the project life cycle.
The Simplilearn VCE exam is free and based on the PMBOK Guide. It includes 200 multiple-choice questions. Test-takers have 240 minutes to complete the practice exam. They can pause and continue the test at any point and attempt the exam as many times as they want.
Taking this lengthy test from beginning to end can help build your mental stamina in preparation for the real deal. Skillup by Simplilearn offers a free PMP basics course if you need more study time before taking the practice test.
Udemy’s free PMP exam prep course covers various introductory project management concepts. The five-unit course—plus one paid self-promotion unit—walks through each course using short video lessons that total just 1.5 hours.
The Udemy course can be helpful for those who are just starting project management careers or seeking more information about the PMP exam.
This free 200-question practice exam uses Google Forms. Once the test is complete, your results include a final score and provide feedback that references specific sections of the sixth-edition PMBOK Guide.
Some practice questions address concepts covered in the PMBOK Guide, and some refer to Agile or adaptive methodologies. This test can give you a broad sense of the questions you’ll find on the PMP certification exam. Those interested in the PMI Agile Certified Practitioner exam can benefit from this VCE exam as well.
Unlike the other free practice exams on this list, this resource offers three difficulty levels. The easiest level is not timed and gives instant feedback after each question. The second has a two-hour time limit and provides feedback at the end. The third and most difficult level limits your time on each question.
This exam comprises 90 questions and explains the correct answers after submission. The test also shares your accuracy on each of the PMBOK Guide performance domains, helping you identify areas that might require more study time.
Since June 24, 2022, when the supreme court ended the federal constitutional right to abortion by overturning Roe vs. Wade, many people have been scrambling to figure out what this means for their bodily autonomy, family planning, and contraception choices. Though there are still options available for acquiring an abortion, emphasis on methods for preventing pregnancy has significantly increased with good reason. As a result, many people with penises, including men, nonbinary people, and trans women, have discussed or considered the option of getting a vasectomy.
This minor surgical procedure is an important option for people making sexual health, birth control, and family planning decisions, though it is important to stress that it shouldn't be a blanket solution for the loss of abortion access to so many millions of people in the United States now face. Vasectomies, though important and valuable in securing your bodily autonomy, have been and continue to be weaponized against minorities in efforts of forced sterilization to their contextual history in the eugenics movement. This is especially true for incarcerated people of color, Black Americans, immigrants, indigenous people, and people with disabilities, according to Harriet A. Washington in her essential text Medical Apartheid: The Dark History of Medical Experimentation on Black Americans from Colonial Times to Present. Throughout history, state-sanctioned or medical practitioner enforced vasectomies have been pushed on people with marginalized identities as a direct way to prevent them from continuing to have children. The implications of this violence are really important to know and understand in the face of this loss of rights via the fall of Roe vs. Wade.
Additionally, it should be pointed out that another aspect of abortion's essential medical care value in reproductive health is that it can terminate a pregnancy without the risk of permanent sterilization or infertility. Though vasectomies can be reversed, experts recommend that you don't get one with the intent to reverse them later on, says Peter Stahl, MD, urologist, and SVP of men's sexual health and urology at Hims & Hers. "For all intents and purposes, vasectomies are typically considered permanent because the procedure to reverse them is highly technical, and your chances for a successful reversal go down every year after you have the procedure," Dr. Stahl says.
For those that want vasectomy, though, the basics of how to get one, what happens during the procedure, and what it feels like are important to know.
A vasectomy is a minor surgical procedure performed on people with a penis to act as a contraception method. "This technique works by intentionally blocking the transport of sperm through the vasa deferentia, or the tubes that connect the testicles to the urethra," says Dr. Stahl. This does not alter one's sexual function, ability to orgasm, or ejaculation ability, all of which stay intact and return to normal a couple of weeks after the procedure.
"You can get a vasectomy by consulting with a urologist or other healthcare professional," says Dr. Stahl. "The consultation involves answering some basic questions about your medical and reproductive history and having a physical examination to make sure that you are a good candidate for the procedure."
In some states, the consultation can be performed on the same day as the vasectomy, and in other states, there is a mandatory waiting period between the consultation and the genuine procedure, Dr. Stahl says. "Most vasectomies take about 30 minutes and are performed in an office setting under local anesthesia, but vasectomies can also be performed under sedation or other forms of anesthesia," he adds.
"Vasectomies can be uncomfortable for some people, but local nerve blocks are very effective at greatly reducing and usually altogether eliminating pain during the procedure," Dr. Stahl says. Afterward, it is common to feel a dull ache for one to two days, but that can usually be controlled with anti-inflammatory medications, icing the area, and wearing a scrotal supporter.
It is recommended that one avoids sexual activity for a period of time after the procedure to allow the site to heal fully and avoid any tenderness. Once you can resume sexual activity, it's still important to use another method of contraception until a post-op vasectomy analysis has been performed. According to Dr. Stahl, this will determine if the procedure worked and if there is any residual sperm in your ejaculate. This is really important to know and remember when the intent of getting a vasectomy is to prevent pregnancy.
A common misconception is that vasectomies impact sexual function. "In particular, people are often worried about changes to ejaculation and losing the ability to get and maintain an erection," says Dr. Stahl. "Since only about one to two percent of the ejaculate volume comes from the testicles, there is no noticeable impact on the quantity of semen expelled from the penis during ejaculation."
Additionally, Dr. Stahl points out that the nerves and blood vessels that control erection are very, very far from the anatomic place where a vasectomy is surgically performed (the spermatic cord), so the vasectomy has no impact whatsoever on physiologic erectile function.
Vasectomies fail about one percent of the time, Dr. Stahl says. "Failure can result from technical errors during the procedure or from spontaneous reconnection of the two cut ends of the vasa deferentia. This is why it is very important to continue using contraception until a post-vasectomy semen analysis indicates that the procedure was successful," he adds.
Vasectomies are reversible. However, reversing a vasectomy is not easy and requires highly specialized microsurgical training, Dr. Stahl says. Success rates range from 70 to 95 percent, depending on the amount of time that has elapsed since the vasectomy and the specific type of procedure required. Reversal procedures are also typically not covered by insurance and can be expensive.
This is an important aspect to note about vasectomies, because some folks talk about them like they are IUDs (in that you can get taken out after a number of years when you're ready to have kids). However, this procedure is best viewed as close to, if not entirely, permanent. You absolutely should have agency over making this choice, but being sure that you don't want to have kids in the future is important to consider as well.
Maj. Gen. Gregg Martin speaks with Chairman of the Joint Chiefs of Staff Gen. Martin Dempsey in June of 2014.
Source: Photo by Sergeant 1st Class Daniel Hinton/Courtesy of Department of Defense
This is Part 1 of a four-part series telling the story of a general’s service and success, followed by mental health disaster and recovery, then new life. The purpose is to raise understanding, build hope, and help abolish the stigma.
“You’ve done an amazing job…Resign, or you’re fired. You need to go get a mental health exam.”
It was mid-July 2014. I was 58 years old, and after more than three decades in the Army, I was a two-star general and President of the National Defense University (NDU), the nation’s highest military educational institution, located in Washington, D.C. The NDU fell under the supervision of the Chairman of the Joint Chiefs of Staff, the country’s top-ranking military officer. And the Chairman had just ordered me to report to his office at the Pentagon the next day.
Something was up. Until very recently, my job performance had been rated as exemplary, and I had received extremely positive feedback. Had the Chairman approved my request for a three-year extension as President of the university? Did he want to reinforce what a great job I was doing and give me guidance for my upcoming third year at the helm? Was he unhappy with me and about to terminate my presidency? Or was it something else? I would soon find out.
The Chairman, General Martin E. Dempsey, was a brilliant, inspirational, and friendly man. He had been a fabulous boss, as well as a colleague, mentor, and friend for nearly 20 years. When I walked into his office, I noticed his lawyer was in the room, which was not a good sign. I saluted the Chairman, and he walked over and gave me a hug.
“Gregg, I love you like a brother,” he said. “You’ve done an amazing job…but your time at NDU is done. You have until 17:00 today to submit your letter of resignation to me, or I will fire you. Is that clear?”
Had I been in a normal state of mind, with a healthy brain, I probably would have been stunned, upset, or disappointed. But I was in a state of acute mania, and I had none of those feelings or reactions. I was already anticipating my next grandiose mission from God.
“A lot of people think you have serious mental health problems. I’m ordering you to get a command-directed psychiatric health exam at Walter Reed. You need to go this week.”
Indeed, my behavior had become erratic and disruptive to the mission. I had lost the confidence of much of the staff and faculty of NDU. I resigned that afternoon. My 35-year military career would end sooner than anticipated.
To be clear, I was not wronged. The Chairman made the right decision. He was taking care of my own health and welfare, as well as his university’s welfare and mission success. Had I been in his shoes, I would have made the same decision. I do not dispute any decision, medical or administrative. Furthermore, I am not a medical doctor, and I believe that the clinicians at Walter Reed are professionals who did their best.
But consider this: One week before I was asked to resign, two medical doctors—my general practitioner and a psychiatrist—had evaluated me and given me a clean bill of health.
“It is my professional opinion that [Major General] Martin is physically and mentally fit for duty,” wrote one. The psychiatrist wrote: “I do not find evidence of psychiatric illness. Specifically, he does not have depression, mania, or psychosis… he is psychiatrically fit for duty.”
The reason I say this is not to criticize but to emphasize how devilishly difficult it is even for medical professionals to recognize and correctly diagnose bipolar disorder, even when it is in an acute state. (Although I do not believe that the two parties—the Chairman’s office and the clinicians at Walter Reed—ever exchanged information or had any kind of discussion, a serious shortcoming in the evaluations.)
That day in the Chairman’s office, it never crossed my mind that I was mentally ill. I felt terrific and was full of energy, drive, and ideas. There was important work to be done. In fact, the week after I had resigned, I was given yet another unremarkable medical examination: “fit for duty.”
Yet the truth is that for more than a decade, I had unknowingly served as a senior leader in the U.S. Army with unknown, undetected, and undiagnosed bipolar disorder. According to medical authorities, my latent genetic predisposition for bipolar disorder was “triggered” in 2003 when I was serving as a colonel and brigade commander of thousands of soldiers during the U.S. invasion of Iraq. It grew worse for nearly a decade, and between 2012 and the summer of 2014, my mania became “acute.” At last, in late 2014, four months after my resignation from the NDU, I spiraled, then crashed, into hopeless, terrifying depression and psychosis. From late 2014 through 2016, I was in a battle for my life.
Had there been warning signs and indications? How did I myself miss them? How did my family, friends, and colleagues miss them? How did the institution I worked for, for so long, miss them? If there were warnings, what were they?
A version of this post was also published in “Task & Purpose.”
Fungi Kwaramba in Gweru
More funding will flow into public medical and health facilities as part of the modernising and equipping of hospitals, clinics and laboratories to create a contemporary and well-resourced health system, President Mnangagwa said yesterday.
Opening the Midlands State University National Pathology Research and Diagnostic Centre in Gweru yesterday, a major testing and research centre that allows a lot of work that had up to now been done outside the country to be carried out locally, President Mnangagwa said this extra financing and modernising would attract Zimbabwean scientists based abroad to return home as well as allow training and research opportunities in Zimbabwe to boost the pool of qualified specialists.
These in turn would help in rebuilding the country towards Vision 2030 to become an upper-middle income economy.
Apart from that, the country stands to benefit from modern health facilities in the tourism sector, especially in resort towns like Victoria Falls where wealthy tourists often raise the absence of state-of-the-art hospitals.
It would also help make Zimbabwe a medical tourism hub.
The President, who is also the Chancellor of all State universities, said his Government was always available to provide funding to universities and colleges implementing the Education 5.0 model.
The model is based on practice, seeking to, among other things, create employers, innovators and scientists as opposed to the previous model that was employment oriented.
Proving his commitment to improving the health sector, it took less than nine months to construct the pathology centre, which was wholly funded by Government, as the President vowed to ensure that Zimbabweans, regardless of status will turn to local facilities when they need medical care.
The facility, a first of its kind in the country, comes packed with equipment for the detection of cancer antigens, a process previously done in South Africa and thus its establishment will save millions of dollars as well as attract foreign medical tourists.
The facility also offers training in pathological disciplines and helps increase the number of pathologists in the country who have been in shortage for some time now.
Apart from that, the facility has CAT and Ultrasound Scans, MRI and some equipment is currently on the high seas headed for Zimbabwe.
This, President Mnangagwa said, positions Zimbabwe as a quality health service provider, not only to Zimbabweans, but also to the region at large.
“The National Pathology Research and Diagnostic Centre being opened today is part of the Second Republic’s efforts to scale up the provision of quality health services for our citizens and realise universal health coverage,” he said.
“This centre further highlights my administration’s determination to address the shortage of local pathologists by creating such specialist training programmes.”
Last November, President Mnangagwa laid a foundation stone for the first-of-its-kind laboratory, itself a reflection of the success of the heritage-based Education 5.0 model that addresses the needs of the people through providing practical solutions.
The model has been given life and form by President Mnangagwa through the creation of industrial parks and innovative hubs which are coming with transformative inventions and solutions beneficial to the country as a whole.
“The new centre is set to increase access to pathology and diagnostic services to a cross-section of people here in the Midlands and indeed throughout the country,” he said.
“I, therefore, challenge the university and its stakeholders to make concerted plans to grow this facility to become a regional centre of excellence. To this end, the appropriate leadership, mentorship, training, examination and accreditation must be pursued towards the churning out of clinicians who meet world class standards.”
The centre is envisaged to drive the local manufacturing of laboratory reagents and point of care devices.
“In view of the present and future disease threats, I exhort the university to move swiftly to develop and grow high-end capabilities for disease surveillance, control and prevention,” said President Mnangagwa.
In line with National Development Strategy 1, the country’s economic development guiding compass, the President urged the private sector to also invest in the health sector in the tailoring of home-grown solutions to any challenges that the nation could be facing, present or future”.
After touring the centre, President Mnangagwa expressed his satisfaction with the number of female scientists who occupy the front seat in the medical facility, saying his administration will avail resources for talented Zimbabweans to flourish and realise their dreams.
“Under the Second Republic, universities and other institutions of higher learning are indeed actualising teachings, research, community engagement, innovation and industrialisation as articulated in the Education 5.0 philosophy,” he said.
“Furthermore, the equipping and construction of other infrastructure such as student hostels and libraries, among other facilities, are being accelerated.”
Universities such as MSU should provide appropriate and holistic complementary services to develop competent pathology practitioners who are able to manage complex laboratory functions.
The medical centre should ride on his foreign policy of re-engagement and engagement to form synergies with other scientists outside Zimbabwe.
“It is encouraging that pathologists at this centre will establish research in partnership with other medical institutions from across the world,” said President Mnangagwa. “Leveraging on the successes of the engagement and re-engagement policy, partnerships in disciplines such as bio-medical engineering; bio-pharmaceuticals, medical bio-technology and vaccinology must enhance our national competencies in these fields.
“As you do so, I challenge the university to foster ‘out of the box’ research and innovation, based on our rich natural resources and cultural heritage.”
President Mnangagwa was accompanied by Vice President Constantino Chiwenga, Minister of Defence and War Veterans Affairs Oppah Muchinguri-Kashiri, Minister of Higher and Tertiary Education, Innovation, Science and Technology Development Professor Amon Murwira, Minister of State for Midlands Province Larry Mavima and senior Government officials.
Zimbabweans, despite the bane of sanctions, have been raising the country’s flag across the globe with scientists from the country making breakthroughs and discoveries that have helped in the fight against diseases like Covid-19, and also the discovery of vaccines.
With such facilities, the President said skilled Zimbabweans can now come back home and help build the country.
A study published in the Journal of the American College of Cardiology revealed that just 6.8% of Americans are in optimal cardiometabolic health. As a family nurse practitioner practicing lifestyle medicine, I am extremely concerned about the other 93.2% of Americans who are not in optimal cardiometabolic health.
Our healthcare system should be concerned too. I was first introduced to the concepts of value-based care and accountable care organizations in 2013 as a performance improvement nurse. In 2022, as we continue to slowly move away from fee-for-service, improving cardiometabolic health will be a crucial component to improving population health.
What Is Optimal Cardiometabolic Health?
So, what exactly is cardiometabolic health and what is optimal? Good questions. Optimal cardiometabolic health is the absence of a series of disorders that increase a person's risk for heart disease or type 2 diabetes. These include hypertension, high fasting blood glucose, abnormal cholesterol levels, excess abdominal weight, and high triglycerides.
The journal study was based on results from the National Health and Nutrition Examination survey. The cardiometabolic risk factors analyzed in this study included body weight, blood glucose, cholesterol, blood pressure, and clinical cardiovascular disease. According to the research, changes in average body weight and blood glucose were the two factors with the greatest impact on decreasing the cardiometabolic health of the population between 1999 and 2018. Optimal body weight was considered a body mass index (BMI) of less than 25 and a waist circumference of less than or equal to 88 cm for women and 102 cm for men. The criteria for optimal blood glucose included not requiring medications for diabetes, having a fasting blood glucose level of less than 100 mg/dL, and a hemoglobin A1C of less than 5.7%. Poor level for body weight was considered a BMI over 30 and a waist circumference larger than the cutoff measurements above. Poor level for blood glucose was a fasting level greater than or equal to 126 mg/dL or a hemoglobin A1C greater than or equal to 6.5%.
Approaches to Improving Cardiometabolic Health
Nine of the top 10 leading causes of death in America have obesity and excess body weight as a risk factor. These include heart disease, certain cancers, COVID-19, stroke, chronic lower respiratory diseases, Alzheimer's disease, diabetes, influenza, and nephrotic syndrome. Heart disease alone costs the U.S. hundreds of billions of dollars each year between treatments, medications, and lost wages due to death. In fact, 90% of healthcare spending in America is related to chronic disease and mental health.
The good news for the 73.6% of U.S. adults who are considered overweight or obese, many of whom are not in optimal cardiometabolic health, is that there are FDA approved weight loss medications available that can help supplement diet and lifestyle changes -- especially when these alone are unsustainable or ineffective at improving various health conditions.
The bad news? Insurance coverage of these medications vary by state, insurance type, and employer plan. These medications are generally not covered by Medicaid or Medicare, including where I practice in Illinois. Even for patients with an employer-based commercial plan, weight loss medications are often not covered.
I've had the opportunity to witness the power of lifestyle modifications coupled with access to medications to help patients meet their health goals. For example, one patient who had been diagnosed with diabetes 11 years prior was struggling with controlling her diabetes and losing weight. We worked together for 6 months, primarily making lifestyle adjustments such as increasing her water intake, reducing her sodium intake, adding vegetables into her daily diet, going to the gym four to five times per week, reducing her carbohydrate intake, and including more protein and healthy fats in her diet. I also referred her to an endocrinology specialist to optimize her medications, such as reducing her diabetic medications associated with weight gain, and to include a GLP-1 agonist, a class of diabetic medications associated with weight loss.
These lifestyle changes along with adjustments in her medications allowed her to reach her health goals. In 6 months, she was able to lose 25 lbs and 6.7 inches (17 cm) off her waist circumference. Her hemoglobin A1C was down to 5.6%, below the diagnosis level for pre-diabetes. She got her diabetes under better control than it had been in the past 11 years. She cried joyful tears in my office because of how good she felt. She thanked me, but I told her that she was the one who put all the hard work in.
Unfortunately, this is a success story not everyone gets to experience.
For this particular patient, the GLP-1 receptor agonist medication was covered by her insurer because it is indicated for the treatment of type 2 diabetes. But there are other GLP-1 receptor agonists, such as liraglutide (Saxenda) and semaglutide (Wegovy), that are FDA approved but often not covered by insurance because their specified use is for weight loss.
This is just one example of how our healthcare system is reactive instead of proactive. Obesity has been recognized by the American Medical Association as a chronic disease since 2013. We need to start treating it as such by providing appropriate coverage for medications and increasing the availability of comprehensive programs with lifestyle medicine, behavioral health, and preventive cardiology. To be sure, primary prevention of obesity and morbid obesity would be optimal and initiatives targeted at that should also be prioritized.
Obesity is a complex chronic disease with roots in metabolic dysfunction, and is impacted by social determinants of health, socioeconomic status, access to healthy food, subsidies to corn and sugar companies, the convenience of fast food, stress, genetics, and so on. It is often not as simple as "eat less and exercise more" -- and that's where medication can provide another line of support.
We have safe and effective medications that are FDA approved for weight loss and have been rigorously tested prior to approval. We need to expand access to these medications by providing universal coverage.
Elizabeth Simkus, DNP, FNP-C, is a family nurse practitioner practicing lifestyle medicine at Rush University Medical Center, instructor in the Department of Community, Systems, & Mental Health Nursing at Rush University College of Nursing, and a Public Voices Fellow through The OpEd Project.
Bridging the gap of research in Ayurveda, which had been long languishing in a time wrap, is a herculean task. There is certainly a lot of ground to cover, but it is now on a threshold for a leap, perhaps.
Technology had provided a major impetus to ayurvedic research and would redefine Ayurveda’s impact – just as it redefined modern medicine and is continuing to do so.
There have been certain streaks of excellence happening in many areas in a short time that has put Ayurvedic scientist, Dr Bhushan Patwardhan, among the top 1% of the scientists in the world by Stanford University.
One of the major drawbacks was the lack of documentation. Recognizing these inherent problems, the new crop of physicians have taken progressive steps – documenting clinical practice and certain diseases.
Covid 19 pandemic was definitely a major trigger for documentation at the clinical level, said Dr V Rajmohan, who was coordinator of the Kerala State Covid 19 Ayurveda Response Cell.
This has led many Ayurveda physicians into studying the various manifestations of the coronavirus disease, particularly the post-Covid 19 rehabilitation. The results have been rather good, he said.
A decade ago, the Chikungunya epidemic had made a major dent in Kerala’s health profile. Even when Ayurvedic practitioners could check the morbidity of the disease with some success, the system never rose to the occasion in documenting it.
When the Covid 19 made landfall, the Ayurvedic practitioners were rueing the lack of documentation as that would have given Ayurveda more acceptance during the Covid 19 pandemic.
When modern medicine leaped ahead with research backings, Ayurveda lagged behind despite some clinical victories. Lack of evidence and research backup had perhaps been a major undoing for Ayurveda relegated to the sidelines.
Even when classical medicines are promoted, allegations continue to bother the proponents of Ayurveda terming them fake. Herbs like Ashwagandha (Withania somnifera), Guduchi (Tinospora cordifolia), Amlaki – the Indian gooseberry, Glycyrrhiza glabra (Yashtimadhu), and Piper longum or Thippali or Pippali are among some of the time-tested drugs in Ayurveda. These along with Ayush 64 were among the drugs that were approved by the Ayush Ministry much later for managing various Covid 19 conditions, but many from the modern scientific community had raised issues of hepatic toxicity against some of these drugs.
Bringing in a researcher’s perspective on these allegations, Dr Rajmohan said toxicity studies are done by using a range of dosages, and in pre-clinical studies when rats were challenged continuously with higher levels of toxicity liver got damaged. However, even then, once the drug is withdrawn, the liver recovers. Nobody reads the last part of the text, he added.
In modern medicine, there have been questionable statistics with Remdesivir, hydroxychloroquine dexamethasone, plasma therapy, and even ventilator therapy for Covid 19, showing just about 20% results, but still, these were recommended for use. However, when it came to Ayurveda, the modern scientific community was extremely biased, said Dr Rajmohan.
The research was the basis of the old Ayurvedic texts, according to the writings of the late legendary Sanskrit scholar and Ayurveda physician from Kerala Raghavan Thirumulpad. Any medical system is as good as it moves along with times based on contemporary research, he had written. But with little political patronage, especially over 200 years under British rule, Ayurveda faced neglect and was side-lined as modern medicine made its way, wrote Thirumulpad.
The science of anesthesia was the turning point in modern surgery. It was introduced into India as part of modern medicine, and that was perhaps one of the many reasons why Ayurveda shelved its surgical branch and moved ahead, believed the scholar.
Despite the loss of centuries of research, Ayurveda could take the leap with a lot of focus areas, believes Dr Geetha Krishnan, Technical Consultant, Ayurveda, World Health Organisation. A lot of ground needs to be could be covered in the backdrop with fundamental research. Ayurvedic preventive medicine could be a major focus in public health, he said.
Research on drugs had been a key occupation even eons ago, as is evident in various commentaries on the Ayurvedic treatises. The concept of Ayurveda has not undergone any change. It is the diseases and new findings of treating diseases that have got updated in most of the commentaries by various scholars spread over various time frames over the millennia.
While the impact earlier was directly in clinical practice, modern research in Ayurvedic drugs is happening in the industrial sector.
There is a plethora of classical drugs. In fact, there is no need to make new drugs as the classical drugs have not been explored to their worth, said Dr Remya Krishnan, professor in Ayurvedic pharmacology, Ayurveda Medical College, Mahe.
There are a number of processes as well as product research done by the industry, said Dr Sindhu A, vice president, Technical, Arya Vaidya Pharmacy. In any industrial setup, new product development is the main focus – maybe about 80%, she said.
Process research is to find whether drugs made out of the slow grinding or slow boiling processes have better efficacy or whether new technological processes are suited to Ayurveda, said Dr Sindhu.
Outside pharmaceutical precincts, there is little fundamental research – using Ayurveda as a methodology or a tool to evaluate health and diseases – happening in Ayurveda, rued Dr M. Prasad, noted clinical researcher and academic in Kerala.
Both fundamental research and a multi-disciplinary approach in Ayurveda are badly missing, especially in Kerala, where there is a social acceptance of the indigenous system and a large number of people seek Ayurveda as the first intervention for many diseases, said Dr Prasad.
Dr Prasad along with other researchers like Dr P Ram Manohar, director, Amrita Advanced Ayurvedic Research Centre, and Dr Vasudevan Namboothiri, former director of Ayurveda Medical Education, Kerala, had been among the first to conduct an Ayurvedic profile of Covid 19 patients in Medanta Hospital in New Delhi on patients from Italy in 2020, at the beginning of the outbreak in India.
Research methodologies in Ayurveda are different from modern medicine and hence not comparable, but at the same time international standards are being evolved to make Ayurvedic science acceptable on a wider canvas, said Dr Ram Manohar.
Despite the slag, some of national research institutes have built up a body of work. But how much of it has impacted Ayurveda practice needs to be critically analyzed.
The National Research Institute for Panchakarma at Cheruthuruthy in Kerala is one such institute that has built up work over the last 40 years. Earlier the focus was more on clinical research on new drugs and patents while now the emphasis is on evidence creation that will empower the Ayurveda physicians in their clinical practice, said V. C. Deep, assistant director, NRIP.
Documenting the prognosis of the disease in the Out-Patient as well as In-Patient departments with radiological images and physical examination before and after treatment had been one of the major works that have helped create an impact, he said.
Panchakarma is a technique involving various methods of detoxing the body and preparing it for further ayurvedic treatment. Sometimes the detoxing techniques themselves would be enough as treatment. Kerala had preserved the methods of panchakarma in its traditional manner much better compared to any other part of the country.
The Institute offers training to Ayurveda doctors about the various processes in Panchakarma. The Institute has come out with a booklet on Standard Operating Procedures (SoP) for Panchakarma, which has become a ready reckoner for any Ayurvedic practitioner.
Much confusion prevailed among physicians as to when and how to do each karma, said Dr Deep. The SoP irons out such muddles.
Another major work of the Institution was a research project titled Documentation of Effective Marma Practices. The outcome was a book titled Marma Chikitsa – Basic Tenets in Ayurveda and Therapeutic Approaches published in February 2021. The work is likely to impact Ayurveda practice in the country as the Ministry of Ayush is planning to make the traditional healing therapy as part of the Ayurvedic practice, making it part of college-level studies, said Dr Deep.
The shortage of medicinal plants is a prime concern in Ayurveda. Pointing out the wide gap in the availability, Dr P Ram Manohar, chief researcher at Amrita, said that, of the 10,000 medicinal plants listed by the Medicinal Plant Board of India, only 300 are actively used. Focus is required to research replacing a herb in a formulation without losing its efficacy or perhaps with better efficacy. Knowledge about abhava dravyam in olden texts indicated by Ayurvedacharyas can thus be furthered with modern research.
An anti-arthritic drug called Rasanaerandi kashayam has an important ingredient called Ativisha – Aconitum heterophyllum, which is an endangered species, hence costing a premium. Research for other plants that could be as effective would be a major breakthrough.
Research methodologies, previously not known to Ayurveda students, have prompted many Ayurveda students at post-graduate level or post-doctoral research, to publish papers, even though it is not mandatory, said Dr Sudhi Kumar, professor, co-ordinating the functioning of the new School of Fundamental Research in Ayurveda, a government initiative under KUHS.
It may take years to build up evidence to make Ayurveda the first preference in preventive medicine. Modern medicine, which had the advantage of technology and patronage of governments has not really brought about outstanding research in the last 250 years. Ayurveda’s modern avatar in Independent India is only about 50 years old.
Internship program connects Latino students with careers in health care
As high school students, Camila Delgado Garcia and Joerdy Flores-Garcia both were interested in health care careers.
So the Omaha youths signed up for a health and wellness internship offered by the Latino Center of the Midlands and CHI Health. Their internships helped them decide what they wanted to do.
Both became certified nursing assistants through the program, which covered their costs. Both will be freshmen at the University of Nebraska at Omaha this fall and have their sights on becoming dental hygienists. Flores-Garcia plans to apply to work through college at CHI Health to help cover expenses.
Delgado Garcia said a lot of careers are available in health care that people don’t know about. “If you don’t like one, there’s hundreds more that go into it,” she said.
The program is one of a growing number of initiatives in Nebraska aimed at helping attract and connect young people to health care careers. The larger goal: Grow the state’s health care workforce.
Even before the COVID-19 pandemic, the state had long-running shortages of many types of health care professionals. The pandemic has exacerbated those shortages, causing some health care workers to retire early or leave the profession. Others left for more lucrative traveling medical jobs. Hospitals, long-term care facilities and home health and hospice outlets all have struggled to maintain adequate staff.
Jeremy Nordquist, president of the Nebraska Hospital Association, said hospitals still are seeing a staff vacancy rate of between 10% and 15%, with some as high as 20%. Some larger systems still rely on a significant number of traveling medical professionals.
On the positive side, he said, some travelers are starting to return to their former employers. Rates charged by medical staffing agencies for travelers have begun to inch down. Anecdotal reports from large systems also indicate that some retired nurses are reassessing the impact of inflation on their finances and returning to work.
But just as worker shortages have helped drive wage increases in other industries, employers in the health care sector also are seeing increased labor costs. Many hospitals and nursing homes have increased wages and offered bonuses to recruit and retain staff. They also have had to pay more for travelers to fill needed positions.
Those higher costs, combined with inflation, increased medication costs and other expenses are putting pressure on the bottom lines of hospitals, nursing homes and home health and hospice providers.
Reimbursements from Medicare and Medicaid, which make up 60% to 70% of a typical hospital’s revenue, are set to increase only slightly, Nordquist said. But internal surveys of members indicate that labor costs for hospitals were up nearly 20% over the past two years, while supplies were up 15%, utilities 8% and medication 30% to 40%. Those numbers align closely with a national report prepared earlier this year by the Kaufman Hall consulting firm.
“It’s a tough situation right now,” Nordquist said. “We thought COVID would be the worst of the worst and we’d all be able to catch our breath ... But hospitals are in a real tough spot now financially, and it’s going to take some creative work to pull our way out of this. The big driving piece of it really is the limited workforce and the costs needed to keep up with workforce costs.”
Many of the state’s hospitals are trying different models to make nursing in particular more attractive and bring people back in. Meanwhile, health systems and health colleges are stepping up efforts to recruit young people to fill the pipeline, including offering more scholarships.
State lawmakers earlier this year put a share of the state’s federal COVID relief dollars toward initiatives to bolster the health care workforce. The Legislature allocated $5 million to help rural health care providers pay off college loans, $5 million to provide scholarships for nursing students and $60 million for a rural health complex on the University of Nebraska at Kearney campus, a joint project with the University of Nebraska Medical Center. Also included was $60 million for capital projects at community colleges to grow the state’s workforce, including in health care.
Those efforts are important, Nordquist said, because the state will face a tremendous demographic challenge over the next 10 years as practitioners in the baby boom bracket retire.
According to the Nebraska Center for Nursing, Nebraska will face a shortage of 5,435 nurses by 2025.
A 2022 health care workforce report by UNMC, based on 2021 data, indicates that the number of nurse practitioners in the state had increased significantly and the number of pharmacists increased modestly since 2020.
However, rural areas of the state still lack needed health care professionals, including physicians. Nicole Carritt, director of the UNMC Office of Rural Health Initiatives, said the report doesn’t capture the full impact of the pandemic. She said shortages have been exacerbated since the data was collected.
UNMC has two long-running, successful pathway programs in collaboration with UNK and state colleges focused on bolstering the rural health workforce, Carritt said. Studies show recruiting students from rural and underserved areas and training them close to those communities increases the likelihood that they will practice there.
Nordquist said the Legislature is conducting an interim study under a measure introduced by State Sen. Terrell McKinney, who represents part of North Omaha, to look at ways to grow and diversify Nebraska’s health care workforce.
The hospital association, he said, also is considering ways to collaborate with nursing schools to make sure they don’t lose applicants. The goal would be to make sure that applicants who are turned down by one nursing college are provided information about other programs or are enrolled in a program where they can earn an associate’s degree.
Selene Espinoza, a surgical assistant with CHI Health, said she got involved in the Latino Center/CHI program last year when it added the CNA certification option. She wanted to make sure Latino students were exposed to health care settings and could see people like themselves in those workplaces.
She talks them through the training required for various careers, from CNAs to physicians, as well as their earning potential. She takes them on tours of hospitals and clinics, where they meet health professionals, don gowns and gloves and get their hands on equipment, including a surgical robot.
Espinoza moved to the United States from Mexico as a preteen. As a student at Omaha’s Bryan High School, Espinoza said, she didn’t think a career in health care was possible because of language and financial barriers. Her parents hadn’t gotten a higher education and didn’t know the U.S. education system. But she was exposed to career options in a program through Midlands Hospital. She now serves on the hospital’s community board and is a member of the Douglas County Board of Health.
“I feel like I’ve walked the path and can do a little bit of guidance,” Espinoza said, noting that the pandemic also highlighted the need for health care workers who could speak patients’ languages and understand their cultures.
Ricky Solis, a UNO junior who joined the program this year, had sought to one day work for an international health organization. But he has shifted his focus to local public health after working for the Central Public Health District in Grand Island during the pandemic and for the Latino Center/CHI program.
“I’m working on the stuff I’ve studied in college,” he said.
Bolstering the existing workforceWhile the staffing crunch for hospitals has eased since the last pandemic peak, hospitals still are busy, in part because they’re catching up with delayed care.
Sue Nuss, chief nursing officer at Nebraska Medicine, said the health system had 450 employees out with COVID at the peak of the omicron surge in January and February. Both that and the number of patients ill with COVID have decreased significantly, although COVID continues to sideline some employees.
Since then, the health system, like many others, has increased compensation packages for bedside nurses. Like other health systems, Nebraska Medicine still employs travelers, although Nuss said it has fewer than at the pandemic peak. It also added 130 nursing school graduates and 90 nurse residents this spring.
But with projections indicating that the number of nurses never will be adequate, Nuss said, the health system is trying out different care team models. It has brought licensed practical nurses back to inpatient units, a role it had eliminated years ago, and also has some paramedics working in those units.
Rather than having one nurse alone oversee four or five patients, for instance, that nurse might instead cover eight or nine patients with the help of an LPN, nursing assistant and paramedic, Nuss said. While stretching nurse-to-patient ratios can impact quality of care, having a team allows nurses to delegate some tasks. By working together, a team may be able to care for more patients.
Tim Plante, chief nursing officer for CHI Health, said that health system also has focused on incentivizing nurses who have stayed and working to get new ones in the field.
A number of health care workers who left for traveling jobs have started to return, he said. So far, 100 practitioners, from nurses to respiratory therapists, have joined the health system’s new internal travel pool. Some have come from across the country.
CHI Health also is trying several new programs aimed at increasing job flexibility, Plante said. Under a weekend option, instead of working every third weekend, the local standard, a nurse could work every weekend or every other weekend in exchange for additional pay. That option works for a lot of nurses with families who want to arrange child care around their shifts.
The health system also is incentivizing nurses to learn new skills and work in different areas — say, the intensive care unit in addition to labor and delivery — and to work in different metro-area hospitals.
CHI Health also has two pilot programs that involve bringing pharmacists and occupational therapists onto floors to help nurses with tasks such as administering complex IV medications and helping patients with strength training.
Russ Gronewold, president and CEO of Lincoln-based Bryan Health, said the system is down to 470 open positions from a peak of 550 during the last pandemic peak. It’s also down to 110 travelers of all types from a high of 170.
In the short term, Bryan has adjusted wages, offered retention bonuses and restored team-building activities such as company picnics and zoo nights. Health system officials are trying to figure out how to accommodate workers’ desire for flexibility, which has increased as wages have increased.
The health system also has started an internal traveler pool, Gronewold said, and has been able to get some employees who had been traveling elsewhere to commit to moving among Bryan’s hospitals in Lincoln, Grand Island, Kearney and Central City.
Gronewold said he also sees a role for more technology. Bryan is using artificial intelligence to extend staff in some areas, including working with a Lincoln software firm to monitor patients at risk of falling with 3D cameras and a fall-predicting algorithm. That has freed about 30 people a day who otherwise would be sitting with patients.
Other systems monitor incoming test results and alert nurses if interventions are needed right away and pre-sort lab results and CT scanner images to help practitioners pick up on any problems more quickly.
“These are things that make their job more efficient, but it doesn’t replace the person who does the job,” Gronewold said.
Ivan Mitchell, CEO of Great Plains Health in North Platte, said his hospital also is bringing back LPNs, medical assistants, certified nursing assistants and paramedics.
If a task doesn’t have to be done by a nurse, he said, “we’re having it be done by someone else.” The same generally goes for physicians.
Mitchell and Gronewold said Nebraska practice standards required some professionals to perform tasks that could be done by others with lesser training. Making such changes would require legislation, and hospital officials are discussing the idea with state lawmakers.
“There are no projections that suggest it’s going to be anything but a long-term issue,” Gronewold said of the shortages. “Simply increasing the folks going to nursing school by 10 or 20%, that still doesn’t even address 50% of the shortage. We have to come up with other programs, of how do we use technology, how do we use other individuals.”
Great Plains has taken a different approach to recruiting. Mitchell said the health system began recruiting nurses from the Caribbean, the Philippines and other nations after he arrived more than six years ago. The nurses all have passed the certification exams that allow them to practice. Since 2018, the hospital has employed about 175 international recruits.
Many move on after their three-year contracts run out, Mitchell said. But some stay. And while they’re in North Platte, their children go to school there. They pay rent and shop in the community. If they move elsewhere in the U.S., they remain part of the larger pool of health care workers.
Nursing home challengesMeanwhile, both nursing homes and home health and hospice outlets face workforce and financial challenges of their own. A side effect, Mitchell said, is increased length of stay for patients in hospitals because nursing homes don’t have the staff to take them. Some nursing homes have closed.
Jalene Carpenter, president and CEO of the Nebraska Health Care Association, said a lot of nursing homes still are ending up in outbreak status due to COVID, meaning a single resident or employee has tested positive. Some employees have left due to requirements for testing and protective gear, which are stricter than in other industries.
A survey of 759 nursing home providers in mid-May by the American Health Care Association indicated that 98% of homes are having difficulty hiring staff. In addition, 73% are concerned about having to close their facilities over staffing woes.
In Nebraska, home operators have not only raised wages but also are looking at other strategies to grow their workforce, Carpenter said. At the national level, the association recently advocated for shortening the wait time for people in the country who are on certain visas to be eligible to work.
Still relatively new to the industry is an online labor platform for long-term care facilities called KARE, which is in place in Omaha and Lincoln. It works a bit like an Uber program for staffing and is “seeing incredible success,” Carpenter said.
With KARE, facilities can post available shifts, and caregivers interested in work can select the ones that work for them — say, a four-hour shift on a Tuesday. Employers, rather than staffing agencies, set the wages. If the employer likes the worker, they can offer to hire the person.
“Those are the things that give me hope,” Carpenter said. “Innovation comes from times of crisis, and we are seeing (people) coming up with new and innovative things.”
Janet Seelhoff, executive director of the Nebraska Association for Home Healthcare and Hospice, said agencies are having to turn away patient referrals because they can’t staff enough nurses and aides. That comes in the face of growing demand for such services.
“Need is greater than it’s ever been,” she said, “but at the same time, there are challenges in staffing.” Costs have gone up with inflation, and home health and hospice agencies can’t compete with the hiring bonuses and benefit packages hospitals and other health care settings are offering.
Building the pipelineMeanwhile, the push continues to get more people into the health care pipeline, with the help of a host of programs, scholarships and loan repayment programs. Colleges and universities continue to reach out across the state to build programs in more locations.
Deb Carlson, president of Nebraska Methodist College, said the pandemic could have scared people away from the field, but it hasn’t.
“People are saying they want to go into health care because they want to make a difference, they want to make an impact,” she said, acknowledging that publicity about salary increases and loan payback programs also have helped spur interest. For those who don’t want to work directly with patients, plenty of careers are available that aren’t at the bedside.
Employers now are focused on how they can get students in the system even before they have degrees and are offering tuition assistance to help them continue their education once they’re in the door, Carlson said.
Nebraska Methodist College, for instance, offers a free student nursing assistant program that allows people 16 and older to study to become nursing assistants at Methodist Hospital and get paid, on-the-job training with a two-year work commitment. The college also began offering its first full-ride scholarships last year for traditional bachelor’s of nursing students.
Carlson said the college also is doing more to reach out to minority communities and has a free master’s program for existing minority providers who want to go into nursing education, which also is a shortage area.
People who earn degrees in health care have no trouble finding jobs, she said. This year, for the first time, even junior nursing students were being hired.
Gronewold said Bryan is automatically offering jobs to junior nursing students at Bryan College of Health Sciences. The health system also is offering more tuition reimbursement for employees seeking additional education and just rolled out a program covering half the tuition for the children of employees who have been with the system for three years, as long as they stay with the system.
Over the course of the next few years, said Dr. Bo Dunlay, dean of Creighton University’s medical school, Creighton will increase the number of graduating physicians from 600 to 1,000. The university also has created two physician assistant programs that eventually will add at least 100 practitioners to the workforce each year. The university also accelerated bachelor of nursing programs in Phoenix and Grand Island.
“It’s created an opportunity for growth,” he said of the expansion. “But the important thing is we’ve got clinical partners there whose missions are aligned with ours, and that’s what makes it so successful.”
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